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. Late-onset sepsis occurs between days 8 and 89. Early-onset sepsis is seen in the first week of life. Neonatal sepsis is a blood infection that occurs in an infant younger than 90 days old.

 Early-onset neonatal sepsis most often appears within 24 hours of birth. The baby gets the infection from the mother before or during delivery. The following increases an infant's risk of early-onset sepsis:    Group B streptococcus infection during pregnancy Preterm delivery Water breaking (rupture of membranes) that lasts longer than 24 hours before birth  Infection of the placenta tissues and amniotic fluid (chorioamnionitis) .

May occur as early as 5 days but is most common after the first week of life  Less association with obstetric complications  Usually have an identifiable focus  › Most often meningitis or sepsis  Acquired from maternal genital tract or human contact .

Proteus. Klebsiella. Primary sepsis › Group B streptococcus › Gram-negative enterics (esp. Staphylococcus. and yeast are most common . coli) › Listeria monocytogenes. flu  Nosocomial sepsis › Varies by nursery › Staphylococcus epidermidis. anaerobes. Pseudomonas. H. E. Serratia. other streptococci (entercocci).

hand washing in the NICU . chorio) Resuscitation at birth.         Prematurity and low birth weight Premature and prolonged rupture of membranes Maternal peripartum fever Amniotic fluid problems (i. variations in immune function.e. race. fetal distress Multiple gestation Invasive procedures Galactosemia Other factors: sex. mec.

rashes. hypotension  Metabolic  Hypo or hyperglycemia. diarrhea. vomiting. jaundice  Feeding problems  Intolerance. retractions. changes in tone  Skin changes  Poor perfusion. pallor.  Temperature irregularity (high or low) Change in behavior  Lethargy. apnea. abdominal distension  Cardiopulmonary  Tachypnea. flaring. tachycardia. mottling. cyanosis. metabolic acidosis . petechiae. irritability. grunting.

 Cultures › Blood  Confirms sepsis  94% grow by 48 hours of age › Urine  Don’t need in infants <24 hours old because UTIs are exceedingly rare in this age group › CSF  Controversial  May be useful in clinically ill newborns or those with positive blood cultures .

glucose.2 is of good predictive value › Serial values can establish a trend   Platelet count › Late sign and very nonspecific Acute phase reactants › CRP rises early. sodium . monitor serial values(≤10 mg/L) › ESR rises late  Other tests: bilirubin. White blood cell count and differential › Neutropenia can be an ominous sign › I:T ratio > 0.

 CXR › Obtain in infants with respiratory symptoms › Difficult to distinguish GBS or Listeria pneumonia from uncomplicated RDS  Renal ultrasound and/or VCUG in infants with accompanying UTI .

Babies in the hospital and those younger than 4 weeks old are started on antibiotics before lab results are back.  Babies who do require treatment will be admitted to the hospital for monitoring.  Older babies may not be given antibiotics if all lab results are within normal limits.  .) This practice has saved many lives. Instead. (Lab results may take 24-72 hours. the child may be followed closely on an outpatient basis.

 Antibiotics › Primary sepsis: ampicillin and gentamicin › Nosocomial sepsis: vancomycin and gentamicin or cefotaxime › Change based on culture sensitivities › Don’t forget to check levels .

hyponatremia) and treat with fluid restriction  Treat hypoglycemia/hyperglycemia and metabolic acidosis  Metabolic .    Respiratory Cardiovascular Hematologic CNS  Oxygen and ventilation as necessary  Support blood pressure with volume expanders and/or pressors  Treat DIC with FFP and/or cryo  Treat seizures with phenobarbital  Watch for signs of SIADH (decreased UOP.